{"id":237396,"date":"2021-11-26T15:05:34","date_gmt":"2021-11-26T20:05:34","guid":{"rendered":"https:\/\/ziliahealth.com\/blog\/diabetic-retinopathy-a-key-role-for-ocular-oximetry\/"},"modified":"2021-11-28T21:27:16","modified_gmt":"2021-11-29T02:27:16","slug":"retinopathie-diabetique-role-cle-pour-oxymetrie-oculaire","status":"publish","type":"post","link":"https:\/\/ziliahealth.com\/fr\/blog\/retinopathie-diabetique-role-cle-pour-oxymetrie-oculaire\/","title":{"rendered":"R\u00e9tinopathie diab\u00e9tique: Un r\u00f4le cl\u00e9 pour l’oxym\u00e9trie oculaire?"},"content":{"rendered":"

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La r\u00e9tinopathie diab\u00e9tique (RD) est la complication la plus courante du diab\u00e8te (DS). C\u2019est une maladie de la r\u00e9tine caract\u00e9ris\u00e9e par de l’isch\u00e9mie, de la n\u00e9ovascularisation et de l’\u0153d\u00e8me.<\/p>\n

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Sur le plan clinique, on distingue deux types de RD: non prolif\u00e9rante et prolif\u00e9rante. La r\u00e9tinopathie diab\u00e9tique non prolif\u00e9rante (RDNP) repr\u00e9sente un stade plus pr\u00e9coce de la maladie et se manifeste par une perm\u00e9abilit\u00e9 vasculaire accrue et une occlusion capillaire. M\u00eame si les patients peuvent \u00eatre asymptomatiques, l’examen peut permettre d\u2019observer des microan\u00e9vrismes, des h\u00e9morragies et des exsudats au niveau de la r\u00e9tine. La r\u00e9tinopathie diab\u00e9tique prolif\u00e9rante (RDP) est un stade plus avanc\u00e9 de la maladie et se caract\u00e9rise surtout par de la n\u00e9ovascularisation, c’est-\u00e0-dire la formation de nouveaux vaisseaux sanguins anormaux en r\u00e9ponse \u00e0 une mauvaise circulation. La RDP peut provoquer une h\u00e9morragie du vitr\u00e9 ou un d\u00e9collement de r\u00e9tine tractionnel, ce qui peut entra\u00eener une grave d\u00e9ficience visuelle. (1)<\/p>\n

Le diab\u00e8te devrait toucher 640 millions d’adultes dans le monde d’ici 2040. La RD touche 1 diab\u00e9tique sur 3 et est la principale cause de perte de vision chez les adultes en \u00e2ge de travailler. (2) Dix ans apr\u00e8s le diagnostic de diab\u00e8te, 71 \u00e0 90 % des patients de type 1 et 67 % des patients de type 2 pr\u00e9sentent des signes de RD. (3)<\/p>\n

Strat\u00e9gies de pr\u00e9vention de la c\u00e9cit\u00e9 caus\u00e9e par la RD<\/h3>\n

Il existe trois grandes approches pour pr\u00e9venir la c\u00e9cit\u00e9 due \u00e0 la RD. La premi\u00e8re est la pr\u00e9vention primaire, qui consiste \u00e0 modifier le mode de vie, \u00e0 utiliser des m\u00e9dicaments et \u00e0 proc\u00e9der \u00e0 un d\u00e9pistage syst\u00e9matique dans le but de pr\u00e9venir la RD. La pr\u00e9vention secondaire tente de diminuer la progression de la RD par le contr\u00f4le des facteurs de risque syst\u00e9miques, des d\u00e9pistages oculaires r\u00e9guliers et l’application de directives fond\u00e9es sur des donn\u00e9es probantes. Enfin, la pr\u00e9vention tertiaire de la c\u00e9cit\u00e9 due \u00e0 la RD implique l’utilisation de traitements ophtalmiques tels que la photocoagulation au laser et la chirurgie pour g\u00e9rer la progression de la maladie. Pour lutter efficacement contre la c\u00e9cit\u00e9 caus\u00e9e par la RD, il est imp\u00e9ratif de se concentrer sur des mesures de pr\u00e9vention primaire et secondaire.(2)<\/p>\n

L’importance d’un diagnostic pr\u00e9coce<\/h3>\n

On estime que la RD commence \u00e0 se d\u00e9velopper jusqu’\u00e0 7 ans avant le diagnostic de diab\u00e8te. Par cons\u00e9quent, la RD peut souvent \u00eatre identifi\u00e9e lors de la premi\u00e8re visite suivant le diagnostic de diab\u00e8te.(4) Une fois la RD diagnostiqu\u00e9e, il est n\u00e9cessaire d’att\u00e9nuer la progression de la maladie pour minimiser le risque de c\u00e9cit\u00e9. Par exemple, selon l’\u00e9tude sur le traitement pr\u00e9coce de la r\u00e9tinopathie diab\u00e9tique (ETDRS) et l’\u00e9tude sur la r\u00e9tinopathie diab\u00e9tique (DRS), l’administration d’une photocoagulation au laser en temps opportun a le potentiel de r\u00e9duire de 90 % la perte visuelle s\u00e9v\u00e8re. N\u00e9anmoins, la d\u00e9tection pr\u00e9coce et le traitement de la RD restent un d\u00e9fi pour les prestataires de soins de sant\u00e9.(3)<\/p>\n

[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=\u00a0\u00bb4.6.6″ _module_preset=\u00a0\u00bbdefault\u00a0\u00bb background_color=\u00a0\u00bbrgba(135,210,150,0.26)\u00a0\u00bb width_tablet=\u00a0\u00bb\u00a0\u00bb width_phone=\u00a0\u00bb90%\u00a0\u00bb width_last_edited=\u00a0\u00bbon|phone\u00a0\u00bb custom_margin=\u00a0\u00bb30px||30px||false|false\u00a0\u00bb border_color_all=\u00a0\u00bb#87d296″ global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4″ _builder_version=\u00a0\u00bb4.6.5″ _module_preset=\u00a0\u00bbdefault\u00a0\u00bb custom_padding=\u00a0\u00bb||||false|false\u00a0\u00bb custom_padding_tablet=\u00a0\u00bb|20px||20px|false|false\u00a0\u00bb custom_padding_phone=\u00a0\u00bb|20px||20px|false|false\u00a0\u00bb custom_padding_last_edited=\u00a0\u00bbon|tablet\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_text _builder_version=\u00a0\u00bb4.14.1″ _module_preset=\u00a0\u00bbdefault\u00a0\u00bb text_font=\u00a0\u00bbMontserrat Regular|500|||||||\u00a0\u00bb text_line_height=\u00a0\u00bb1.25em\u00a0\u00bb quote_font=\u00a0\u00bbMontserrat||||||||\u00a0\u00bb quote_text_align=\u00a0\u00bbleft\u00a0\u00bb quote_font_size=\u00a0\u00bb2rem\u00a0\u00bb quote_line_height=\u00a0\u00bb1.4em\u00a0\u00bb max_width=\u00a0\u00bb782px\u00a0\u00bb module_alignment=\u00a0\u00bbcenter\u00a0\u00bb text_font_size_tablet=\u00a0\u00bb\u00a0\u00bb text_font_size_phone=\u00a0\u00bb1rem\u00a0\u00bb text_font_size_last_edited=\u00a0\u00bbon|tablet\u00a0\u00bb text_line_height_tablet=\u00a0\u00bb\u00a0\u00bb text_line_height_phone=\u00a0\u00bb1.28em\u00a0\u00bb text_line_height_last_edited=\u00a0\u00bbon|tablet\u00a0\u00bb quote_font_size_tablet=\u00a0\u00bb1.5rem\u00a0\u00bb quote_font_size_phone=\u00a0\u00bb1.4rem\u00a0\u00bb quote_font_size_last_edited=\u00a0\u00bbon|phone\u00a0\u00bb quote_line_height_tablet=\u00a0\u00bb\u00a0\u00bb quote_line_height_phone=\u00a0\u00bb\u00a0\u00bb quote_line_height_last_edited=\u00a0\u00bbon|phone\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n

Une avanc\u00e9e majeure dans la gestion de la RD serait la possibilit\u00e9 de mesurer les niveaux de saturation en oxyg\u00e8ne oculaire afin d’\u00e9valuer les changements m\u00e9taboliques avant que les dommages ne se produisent.<\/p><\/blockquote>\n

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Diagnostic de la r\u00e9tinopathie diab\u00e9tique<\/h3>\n

Penchons-nous sur la mani\u00e8re dont nous d\u00e9tectons et suivons la maladie aujourd’hui.<\/p>\n

Ophtalmoscopie<\/h4>\n

Lorsqu’un patient atteint de diab\u00e8te est vu par un professionnel des soins de la vue, une ophtalmoscopie dilat\u00e9e est effectu\u00e9e. Ce test, pratiqu\u00e9 par un ophtalmologiste ou un optom\u00e9triste, a une sensibilit\u00e9 de 65,7 % et une sp\u00e9cificit\u00e9 de 93,8 % pour d\u00e9tecter les signes de la RD.(3)<\/p>\n

Photographie du fond de l’\u0153il<\/h4>\n

La photographie de la r\u00e9tine peut aider \u00e0 identifier et \u00e0 documenter la pr\u00e9sence ou l’absence de RD. La nature statique de la photographie permet une plus grande certitude au niveau de l’observation. Le champ de vision plus large d’une photographie par rapport \u00e0 l’image en ophtalmoscopie directe permet \u00e0 l’examinateur d’avoir une vue plus large de l’\u0153il. La comparaison d’images en s\u00e9rie est \u00e9galement possible, ce qui permet de visualiser les changements dans le temps.<\/p>\n

Tomographie par coh\u00e9rence optique<\/h4>\n

La tomographie par coh\u00e9rence optique (OCT) est un autre outil utilis\u00e9 pour surveiller la RD. L’OCT permet de mesurer l’\u00e9paisseur de la r\u00e9tine, ce qui est particuli\u00e8rement utile en cas de suspicion clinique d’\u0153d\u00e8me maculaire. L’emplacement et l’aspect de l’\u0153d\u00e8me maculaire peuvent \u00eatre caract\u00e9ris\u00e9s par une analyse des images. De plus, l’angiographie par OCT (OCT-A), qui est une modalit\u00e9 d’imagerie permettant la visualisation tridimensionnelle du r\u00e9seau capillaire de la r\u00e9tine et du nerf optique, peut aider \u00e0 identifier les microan\u00e9vrismes, les changements \u00e0 la paroi art\u00e9riolaire, la n\u00e9ovascularisation r\u00e9tinienne et les anomalies microvasculaires intrar\u00e9tiniennes.(6)<\/p>\n

Angiographie \u00e0 la fluoresc\u00e9ine<\/h4>\n

Bien que l’OCT et l’OCT-A soient de plus en plus utilis\u00e9s en raison de leur caract\u00e8re non invasif, l’angiographie \u00e0 la fluoresc\u00e9ine reste la m\u00e9thode de r\u00e9f\u00e9rence pour \u00e9valuer l’isch\u00e9mie et l’\u0153d\u00e8me maculaire. Cependant, elle est co\u00fbteuse en temps et argent, n\u00e9cessite une ponction veineuse, en plus de pr\u00e9senter des risques d’anaphylaxie et de d\u00e9c\u00e8s.(6)<\/p>\n

Malgr\u00e9 que les tests pr\u00e9c\u00e9demment list\u00e9s aient prouv\u00e9 leur capacit\u00e9 \u00e0 diagnostiquer la RD avec pr\u00e9cision, ils se concentrent principalement sur l’\u00e9valuation des dommages d\u00e9j\u00e0 caus\u00e9s \u00e0 l’\u0153il.<\/p>\n

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R\u00e9tinopathie diab\u00e9tique prolif\u00e9rante observ\u00e9e lors d’une angiographie \u00e0 la fluoresc\u00e9ine \u00e0 ultra-large champ. Source : https:\/\/collaborativeeye.com\/<\/p>\n

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Oxym\u00e9trie oculaire<\/h4>\n

De plus en plus d\u2019\u00e9tudes montrent que le d\u00e9r\u00e8glement de l’oxyg\u00e8ne dans l’\u0153il est un indicateur cl\u00e9 de la perte de la fonction m\u00e9tabolique et pourrait donc repr\u00e9senter un facteur physiopathologique crucial de la RD. Ainsi, une avanc\u00e9e majeure dans la gestion de la RD serait la possibilit\u00e9 de mesurer les niveaux de saturation en oxyg\u00e8ne oculaire afin d’\u00e9valuer les changements m\u00e9taboliques avant que les dommages ne se produisent et d’aider \u00e0 pr\u00e9dire le pronostic visuel et la r\u00e9ponse au traitement.<\/p>\n

Au cours des derni\u00e8res ann\u00e9es, la saturation en oxyg\u00e8ne de la r\u00e9tine s’est av\u00e9r\u00e9e \u00eatre un facteur de risque pour le d\u00e9veloppement de la RD. Plus pr\u00e9cis\u00e9ment, Veibi et al ont \u00e9tudi\u00e9 la saturation en oxyg\u00e8ne art\u00e9rioveineuse chez de jeunes patients atteints de diab\u00e8te de type 1 et ont constat\u00e9 que des niveaux plus faibles \u00e9taient un facteur de risque pour le d\u00e9veloppement de la RDNP.(7)<\/p>\n

En outre, il a \u00e9t\u00e9 d\u00e9montr\u00e9 que les param\u00e8tres d’oxym\u00e9trie oculaire changent avant que l’on puisse identifier une progression mesurable de la RD. Par exemple, la saturation en oxyg\u00e8ne dans les gros vaisseaux r\u00e9tiniens peut augmenter et la diff\u00e9rence art\u00e9rio-veineuse peut diminuer avec le temps. Cela sugg\u00e8re que l’oxym\u00e9trie oculaire est soit plus sensible \u00e0 ces changements, soit que ces changements pr\u00e9c\u00e8dent la progression de la RD.(8)<\/p>\n

Ainsi, en utilisant l’oxym\u00e9trie oculaire<\/a><\/span> pour suivre la fonction m\u00e9tabolique au fil du temps, nous pourrions modifier consid\u00e9rablement l’approche de la pr\u00e9vention, du d\u00e9pistage et du traitement de la RD dans le monde entier. Les nouvelles technologies telles que le Zilia Ocular<\/a><\/span> sont porteuses d’espoir sur ce point, car elles permettent de mieux comprendre la sant\u00e9 vasculaire de la r\u00e9tine et l’\u00e9tat m\u00e9tabolique de l’\u0153il. L\u2019oxym\u00e9trie oculaire a le potentiel de devenir un outil clinique important dans la RD en permettant de mesurer la gravit\u00e9 de la RD et de pr\u00e9dire la r\u00e9ponse au traitement.<\/p>\n

Conclusion<\/h3>\n

Le nombre d’Am\u00e9ricains atteints de RD est en augmentation. Entre 2010 et 2050, ce chiffre devrait presque doubler, passant de 7,7 \u00e0 14,6 millions.(9) La RD est une maladie traitable, mais une intervention pr\u00e9coce est essentielle pour mettre en place des traitements ad\u00e9quats afin de pr\u00e9venir la perte de vision. Les nouvelles technologies nous donnent acc\u00e8s \u00e0 des nouvelles informations sur le m\u00e9tabolisme oculaire et nous permettent d\u2019entrevoir un monde sans c\u00e9cit\u00e9 caus\u00e9e par le diab\u00e8te.\u00a0<\/span><\/p>\n

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R\u00e9f\u00e9rences<\/h3>\n

1. Wang W, Lo ACY. Diabetic Retinopathy: Pathophysiology and Treatments. Int J Mol Sci. 2018;19(6):1816. Published 2018 Jun 20. doi:10.3390\/ijms19061816<\/p>\n

2. Wong TY, Sabanayagam C. Strategies to Tackle the Global Burden of Diabetic Retinopathy: From Epidemiology to Artificial Intelligence. Ophthalmologica. 2020;243(1):9-20. doi:10.1159\/000502387<\/p>\n

3. Vashist P, Singh S, Gupta N, Saxena R. Role of early screening for diabetic retinopathy in patients with diabetes mellitus: an overview. Indian J Community Med. 2011;36(4):247-252. doi:10.4103\/0970-0218.91324<\/p>\n

4. Jimenez-Baez MV, Marquez-Gonzalez H, Barcenas-Contreras R, Morales Montoya C, Espinosa-Garcia LF. Early diagnosis of diabetic retinopathy in primary care. Colomb Med (Cali). 2015;46(1):14-18. Published 2015 Mar 30.<\/p>\n

5. Murgatroyd H, Ellingford A, Cox A, et al. Effect of mydriasis and different field strategies on digital image screening of diabetic eye disease. Br J Ophthalmol. 2004;88(7):920-924. doi:10.1136\/bjo.2003.026385<\/p>\n

6. de Barros Garcia JMB, Isaac DLC, Avila M. Diabetic retinopathy and OCT angiography: clinical findings and future perspectives. Int J Retina Vitreous. 2017;3:14. Published 2017 Mar 13. doi:10.1186\/s40942-017-0062-2<\/p>\n

7. Veiby NCBB, Simeunovic A, Heier M, et al. Retinal venular oxygen saturation is associated with non-proliferative diabetic retinopathy in young patients with type 1 diabetes [published online ahead of print, 2021 Oct 20]. Acta Ophthalmol. 2021;10.1111\/aos.15018. doi:10.1111\/aos.15018<\/p>\n

8. Hardarson SH, Stef\u00e1nsson E, Bek T. Retinal oxygen saturation changes progressively over time in diabetic retinopathy. PLoS One. 2021;16(5):e0251607. Published 2021 May 12. doi:10.1371\/journal.pone.0251607<\/p>\n

9. Nei.nih.gov. n.d. Diabetic Retinopathy Data and Statistics | National Eye Institute. [online] Available at: <https:\/\/www.nei.nih.gov\/learn-about-eye-health\/outreach-campaigns-and-resources\/eye-health-data-and-statistics\/diabetic-retinopathy-data-and-statistics<\/a><\/span>><\/span>\u00a0[Accessed 21 November 2021].<\/https:><\/p>\n

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Publi\u00e9 par l’\u00e9quipe Zilia le 26 novembre 2021<\/p>\n

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Lecture additionnelle<\/h2>\n

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\u00c0 propos<\/p>\n

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Zilia Inc. \u00a9 2020 | Privacy<\/a><\/p>\n

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Zilia Inc. \u00a9 2020 <\/p>\n

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Zilia Inc. \u00a9 2021<\/p>\n

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La r\u00e9tinopathie diab\u00e9tique (RD) est la complication la plus courante du diab\u00e8te (DS). C\u2019est une maladie de la r\u00e9tine caract\u00e9ris\u00e9e par de l’isch\u00e9mie, de la n\u00e9ovascularisation et de l’\u0153d\u00e8me.Sur le plan clinique, on distingue deux types de RD: non prolif\u00e9rante et prolif\u00e9rante. La r\u00e9tinopathie diab\u00e9tique non prolif\u00e9rante (RDNP) repr\u00e9sente un stade plus pr\u00e9coce de la […]<\/p>\n","protected":false},"author":3,"featured_media":237376,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"2880","content-type":"","inline_featured_image":false,"footnotes":""},"categories":[17],"tags":[173,131,70,174,69,147],"class_list":["post-237396","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-non-classifiee","tag-diabetic-retinopathy-fr","tag-eye-health-fr","tag-oxymetrie-oculaire","tag-retinopathie-diabetique","tag-soin-des-yeux","tag-ziliaocular-fr"],"yoast_head":"\nR\u00e9tinopathie diab\u00e9tique: Un r\u00f4le cl\u00e9 pour l'oxym\u00e9trie oculaire? - Zilia<\/title>\n<meta name=\"description\" content=\"De plus en plus d\u2019\u00e9tudes montrent que le d\u00e9r\u00e8glement de l'oxyg\u00e8ne dans l'\u0153il est un indicateur cl\u00e9 de la perte de la fonction m\u00e9tabolique\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/ziliahealth.com\/fr\/blog\/retinopathie-diabetique-role-cle-pour-oxymetrie-oculaire\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"R\u00e9tinopathie diab\u00e9tique: Un r\u00f4le cl\u00e9 pour l'oxym\u00e9trie oculaire? 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